Provider Demographics
NPI:1558757062
Name:MEYER CRANIO FACIAL IMAGING & TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:MEYER CRANIO FACIAL IMAGING & TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-942-8000
Mailing Address - Street 1:24 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261
Mailing Address - Country:US
Mailing Address - Phone:603-942-8000
Mailing Address - Fax:603-942-8047
Practice Address - Street 1:24 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261
Practice Address - Country:US
Practice Address - Phone:603-942-8000
Practice Address - Fax:603-942-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03087261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain